Purpose: To describe family perceptions about pediatric primary care management following diagnosis of type 1 diabetes mellitus (T1DM) in preschool-aged children living in the Pacific Northwest region of the United States. Study Design and Method: Mothers of children diagnosed with T1DM before the fifth birthday and within the past two years were recruited anonymously through two regional support groups. Perceptions about pediatric primary care management following T1DM diagnosis were elicited through an anonymous 30-item online survey. Demographic characteristics of mother and child were obtained as well as information about five important domains of health care management for a young child with T1DM: (1) multidisciplinary, (2) holistic and compassionate, (3) accessible and communicative, (4) uses current standards and technology, and (5) actively promotes safe self-management. Results: Twenty-one biological mothers participated in this study, each on behalf of a child diagnosed with T1DM who fit inclusion criteria. Overall mothers held positive perceptions about care management by PCPs and endocrinologists within context of each of the five domains. Most mothers felt included in care planning, valued periodic well-child exams, and believed the child's providers were accessible, communicated effectively, and usually demonstrated consideration/compassion for the family. Although a majority of mothers at least somewhat agreed that the PCP used current standards and technology to care for the child, and functioned as the center of his/her health care coordination, these domains elicited a slightly greater number of responses indicating uncertainty or disagreement. Clinical Implications: Nurses and pediatric practitioners can use findings from this study to plan continued exploration into the perceptions and care management needs of families following diagnosis of a very young child with T1DM. The domains of care used to assess mothers' perceptions about care management-based on tenets of the Chronic Care Model (CCM) and Patient Centered Medical Home (PCMH)-can be used by pediatric PCPs and endocrinologists to dialogue with patients and staff about how care management may be improved for these families. Providing opportunities for feedback to the families of young children with T1DM should be encouraged so future research can examine relationships between care management variables and clinical outcomes.

Bakgrund: Ögonsjuksköterskan möter såväl vuxna som barn inom ögonsjukvården, dock saknas studier som behandlar ögonsjuksköterskans erfarenhet av att vårda barn. Vikten av att anpassa bemötande och kommunikation till barnets ålder och mognadsnivå samt göra dem delaktiga i vården poängteras såväl i svensk lagstiftning som i studier. Detta kan innebära en utmaning för sjuksköterskor som saknar specialistutbildning inom barnsjukvård och sällan möter barn i sin verksamhet. Syfte: Att belysa ögonsjuksköterskans upplevelse av att bemöta och vårda barn vid en ögonakutmottagning. Metod: En kvalitativ intervjustudie där sju ögonsjuksköterskor intervjuades med hjälp av en semistrukturerad intervjuguide. Data analyserades med kvalitativ innehållsanalys. Resultat: Analysen resulterade i fyra kategorier och tio underkategorier, där de fyra kategorierna omfattar: Möte med barn - en positiv utmaning, Skapa en trygg relation, Att bemöta barn är också att bemöta föräldrar samt Vägar till ny kunskap. Konklusion: Ett bättre utnyttjande av ögonsjuksköterskans kompetens på ögonakutmottagningen, där ögonsjuksköterskan kan ta ett större ansvar när det gäller mottagningsbesök med barn, samt ett utökat teamsamarbete rekommenderas. För att kunna bedriva en patientsäker vård bör evidensbaserade riktlinjer utarbetas när det gäller vård och bemötande av barn. Barns och föräldrars upplevelser i samband med besök på ögonakutmottagningen kan närmare beforskas i syfte att utveckla omvårdnaden. / Background: The ophthalmic nurse meets both adults and children in the ophthalmic care, there is a lack of studies regarding the ophthalmic nurse’s experience when it comes to meeting children. The importance of the health care staff adapting the treatment and communication to the child's age and level and involving them in care is emphasized in Swedish legislation, as well as in studies. This can pose a challenge to nurses who lack specialist training in child care and rarely encounter children in their work. Aim: The aim of this study was to illustrate the ophthalmic nurse’s experience of meeting and caring for children in the eye emergency room. Method: The study has a qualitative research approach based on semi-structured interviews with seven ophthalmic nurses. The data was analyzed using qualitative content analysis. Result: The analysis resulted in four categories and ten subcategories, where the four categories are: Meeting the child - a positive challenge, Creating a safe relation, Meeting children is also meeting parents and Ways to new knowledge. Conclusion: A better use of the ophthalmic nurse’s competence in the eye emergency room and improvement of team collaboration are recommended. To be able to carry out a safe patient care there is a need for evidence-based guidelines regarding care and treatment of children. Finally, suggestion of further research on children's and parents' experience of nursing in the eye emergency room is recommended.

Introduction: Burnout is an occupational condition characterized by emotional exhaustion, depersonalization, and a low sense of personal accomplishment. While medical students begin schooling with mental health profiles similar to or better than peers who pursue other careers, there is a downward trajectory throughout school suggesting this phenomenon often originates in medical school. For physicians and residents, burnout has been linked to poor outcomes such as patient safety, might contribute to suicidal ideation and substance abuse, and may undermine professional development. Furthermore, there is a lack of surveillance of the prevalence of medical student burnout in a small-sized school setting. Methods: The Maslach Burnout Inventory (MBI), a 22-question survey, is largely accepted as the gold standard for assessment; however, we utilized the 7-question, Well-Being Index (WBI), which has been shown equal efficacy as the full MBI. Eligible participants were currently enrolled in their respective class at the East Tennessee State University Quillen College of Medicine. Each year, a participant was given a WBI survey during the winter season (overall response rate 83%, n = 239). Results: Overall the self-reported burnout rate over the two-year study period was 65.2% and was significantly higher in those reporting as female (71%). There was also variation tracking the class from one year to the next. The second year at this institution showed the highest reported amount of burnout (75%, n=145) while the lowest amount of burnout reported was during the fourth year at 47%. Conclusions: Burnout experienced at this institution was reportedly higher than national average. There are limitations to this study as the periods in which medical students were asked to answer the survey were consistently at the same time in the calendar year, but the host institution’s curriculum had been changed so that it might not match up accordingly. Furthermore, class sizes changed from year to year and might skew the data. This information suggests that burnout prevalence is higher at Quillen College of Medicine and intervention strategies to address burnout should be pursued.

Bakgrund: Utskrivningsprocessen har förändrats på grund av sjukvårdsreformer med mål att stärka patienters ställning och förkorta vårdtider inom sluten vård. Samtidigt som en åldrande befolkning med ökande multisjukhet och komplexa vårdbehov ställer höga krav på samverkan mellan berörda parter. Äldre patienters upplevelse av utskrivningsprocessen är av intresse för sjuksköterskor i rollen som samordnare av insatser under utskrivningsprocessen. Syfte: Syftet var att belysa äldre personers upplevelser av utskrivningsprocessen från slutenvård till primärvård. Metod: Efter en kvalitetsgranskning gjordes en litteraturöversikt enligt Fribergs metod på nio kvalitativa och tre kvantitativa studier ur databaserna CINAHL och PubMed. Resultat: Ur analysen identifierades fem teman under utskrivningsprocessen och var patienters: informationsbehov och vårdpersonalens betydelse, känsla av utsatthet, nöjdhet och tillfredställelse med vården, strategier och empowerment, samt anhörigas betydelse för patienterna. Slutsats: Äldre patienter upplevelser av utskrivningsprocessen var brist på delaktighet och samordning vilket gav upphov till känslor av oro, stress, förvirring och maktlöshet. Patienter upplevde en ojämlik tillgång till insatser, i synnerhet personer ≥ 80 år. Bristande kommunikation mellan vårdpersonal och patienter påverkar patienters upplevelse av utskrivningsprocessen negativt och orsakade vårdlidande. / Background: The hospital discharge process (DP) has changed due to healthcare reforms whose aim has been to promote the status (voice) of patients and to shorten hospital stays. At the same time as an ageing population with increased multimorbidity and complex care needs puts high demands for integrated care on the partners concerned. Elderly patients’ experiences of the hospital discharge process are of interest to nurses in their role as coordinators of integrated care during the discharge process. Aim: The aim was to highlight older persons’ experiences of the discharge process from inpatient to primary care. Method: Following a quality review, a literature review was conducted according to the method by Friberg on nine qualitative and three quantitative articles from the databases CINAHL and PubMed. Results: From the analysis five themes emerged during the DP and were patients’: need for information and the importance of care personnel, feeling of vulnerability, satisfaction with health care, strategies and empowerment as well as the importance of relatives for the patients. Conclusion: Older patients’ experiences of the DP were lacking in participation and integrated care which aroused feelings of concern, stress, confusion and powerless. Patients experienced an unequal access to care and support, especially persons ≥ 80 years. Lack of communication between care professionals and patients influence patients experience of the DP negatively and can lead to health care-induced suffering.

Bakgrund: 2019 drabbades 65 956 människor av cancer. Cancersjukdomar växer globalt och rädslan av att drabbas av cancer är stor. Den onkologiska vården i Sverige ska ges utan dröjsmål och med uppföljning. Standardiserade vårdförlopp (SVF) syftar till att personer som genomgår utredning för cancermisstanke i största möjliga utsträckning får erfara en helhetsorienterad, välorganiserad och professionell vård. Patienternas upplevelser och nöjdhet med vården kan visas i mått med Patient Reported Experience Measures (PREM). Stödet från sjuksköterskor betyder mycket för patienter som genomgått onkologisk vård.Syfte: Syftet var att beskriva upplevelser av vården hos patienter som genomgått onkologisk vård.Metod: En empirisk studie med kvalitativ ansats och beskrivande design. Fritextsvar från en enkätundersökning analyserades med hjälp av kvalitativ innehållsanalys.Huvudresultat: Övergripande temat i studien var att patienterna beskrev att deras upplevelse av den onkologiska vården var beroende av deras helhetssyn på den erhållna vården. En tillfredsställande vårdupplevelse karaktäriseras av att den består av en sammantagen vårdupplevelse med gott bemötande och förhållningssätt från vårdpersonalen, adekvat och förståelig information, att vården erhållits inom, enligt patienten, rimlig tidsram samt med god följsamhet.Slutsats: Föreliggande studie har undersökt vad patienter som genomgått onkologisk vård har för upplevelser av den erhållna vården. Resultatet visade att helhetsupplevelsen är större, detta belyser föreliggande studie. När alla dessa aspekter fungerat väl så har patienterna i stor utsträckning erfara en tillfredsställande helhetsupplevelse. / Background: In 2019 65 956 people were affected by cancer. Cancer diseases are growing globally and the fear of getting cancer is great. Oncological care in Sweden must be provided without delay and with follow-up. Standardized care processes (SVF) aim to enable people who undergo an investigation for cancer suspicion to experience a holistic, well-organized and professional care to the greatest possible extent. Patients' experiences and satisfaction with care can be shown in dimensions with Patient Reported Experience Measures (PREM). The support from nurses means a lot to patients who have undergone oncological care.Aim: The aim was to describe experiences of care in patients who have undergone oncological care.Method: An empirical study with a qualitative approach and descriptive design. Free text responses from a survey were analyzed using qualitative content analysis.Main Result: The overall theme of the study was that the patients described that their experience of the oncological care was dependent on their holistic view of the care received. A satisfactory care experience is characterized by the fact that it consists of an overall care experience with good treatment and attitude from the care staff, adequate and understandable information, that the care was obtained within, according to the patient, a reasonable time frame and with good compliance.Conclusion: The present study has examined what patients who have undergone oncological care have for experiences of the care received. The results showed that the overall experience is greater, this highlights the present study. When all these aspects have worked well, the patients have to a large extent experienced a satisfactory overall experience.

Bakgrund: Både patienter och sjuksköterskor uppger att deras välmående är avsevärt bättre när sjuksköterskan vårdar med empati och de kan etablera en relation till varandra. Compassion fatigue (CF) är en stressrespons som drabbar personer i vårdgivande yrken, där sjuksköterskan påverkas både fysiskt och psykiskt.    Syfte: Att undersöka om och hur den personcentrerade omvårdnaden och dess kvalité påverkas när en sjuksköterska drabbats av CF.    Metod: Deskriptiv litteraturstudie som inkluderar 14 artiklar med kvalitativ och kvantitativ forskningsansats. Litteratursökningen utfördes i databaserna PubMed och CINAHL.    Resultat: Resultatet visar att den personcentrerade omvårdnaden indirekt försämras när sjuksköterskan drabbats av CF. Sjuksköterskans förhållningssätt gentemot patienten påverkades och patienterna ansåg att medkänsla var en huvudkomponent i god omvårdnad. Det identifierades två teman: Empatins betydelse för den personcentrerade omvårdnaden samt Emotionella och kognitiva reaktioner påverkar sjuksköterskans engagemang. Temat Empatins betydelse för den personcentrerade omvårdnaden har två underkategorier: Patienten upplever minskad förståelse och empati samt Bristande kvalité av omvårdnaden.    Slutsats: Det huvudsakliga resultatet visade att sjuksköterskans CF har en inverkan på patientens personcentrerade omvårdnad och kvalitén på omvårdnaden. När en sjuksköterska drabbas av CF får det ofta konsekvenser i sjuksköterskans yrkesutövning och omvårdnaden av patienter blir negativt påverkat. / Background: Both patients and nurses mention that their wellbeing is significantly better when the nurse care with compassion and a relationship is established. Compassion fatigue (CF) is a response of stress that affects caregiving professionals were nurses get physically and mentally affected.  Aim: To investigate if the person-centered care and quality of care are affected when a nurse has CF. Method: Literature review including 14 scientific articles with both qualitative and quantitative approach. Searches were made using the PubMed and CINAHL databases.   Results: The patient-centered care is affected and deteriorated by a nurse with CF. The nurses approach towards the patient were affected and the patients considerate that compassion was a major component of good nursing care. Themes that were identified were: The importance of empathy for person-centered care and Emotional and cognitive reactions affect the nurse's commitment. The theme of empathy for the person-centered care has two subcategories, the patient experiences reduced understanding and empathy and quality of nursing. Conclusion:  The nurse compassion fatigue has an impact on the patient-centered care and the quality of care. When a nurse is affected by CF there is consequences both in the professional life. The patients quality of care will be adversely affected.

Background: Insufficient physical activity is a public health problem. The Swedish recommendation is to be physically active for a minimum of 30 minutes every day, which is fulfilled by about half the adult population. Recent research has shown that sedentary behavior is an independent risk factor. Physical activity on prescription (FaR®) is an individually adapted and written prescription, a method to encourage physical activity. The National Board of Health and Welfare has observed that counseling combined with a written prescription convey better adherence than just counseling. Purpose: The purpose was to describe important factors improving the adherence to FaR®. Method: A literature overview was conducted with intent to go from a thought process to knowledge. Result: Factors like the prescriber, patient’s prerequisites, communication and regularity has been identified as meaningful to the process of FaR® and it´s adherence. Discussion: The knowledge of these factors creates a possibility to further developments of FaR®. The role of the prescriber is important, to interpret and individually adapt the prescription to make the best prerequisites and provide good adherence. Conclusions: To identify these factors, the prescriber, communication, patient’s prerequisites and regularity, creates opportunities to further generate the quality of FaR ® and it´s adherence. / Bakgrund: Fysisk inaktivitet är ett folkhälsoproblem. Rekommendationen för svenska folket är att vara fysiskt aktiv 30 minuter om dagen, vilket uppfylls av ungefär hälften av den vuxna befolkningen. De senaste årens forskning har visat att stillasittande är en oberoende riskfaktor. Fysisk aktivitet på recept (FaR®) är en individanpassad skriftlig ordination, en metod för att främja fysisk aktivitet. Socialstyrelsen har konstaterat att rådgivning i kombination med skriftlig ordination ger bättre följsamhet vid FaR® än enbart rådgivning. Syfte: Syftet var att beskriva de faktorer som har betydelse för följ-samheten vid FaR®. Metod: Litteraturstudien genomfördes som en allmän litteratur-översikt med arbetssättet att gå från en tankeprocess till en kunskapsprocess. Resultat: Faktorer som förskrivaren, kommunikation, patientens förutsättningar och regel-bundenhet har identifierats. Dessa faktorer har betydelse för förskrivningsprocessen vid FaR® och dess följsamhet för patienten. Diskussion: Kunskapen om dessa faktorer skapar möjligheter för vidare utveckling av förskrivningsprocessen. Förskrivarens roll är viktig, att bedöma och att individanpassa ordinatonen så att förutsättningarna för patienten förblir goda och ger följsamhet. Slutsats: Identifieringen av faktorerna förskrivaren, kommunikation, patientens förutsättningar och regelbundenhet skapar möjligheter för vidare kvalitetsutveckling av FaR®.

Hjärtsvikt är ett komplext syndrom med hög morbiditet och mortalitet – och som blir allt vanligare världen över. Avancerad hjärtsvikt kan ha betydande konsekvenser för patienten. Ur denna synvinkel ville vi ta reda på hur patienter med avancerad hjärtsvikt upplever sin situation. Syftet med litteraturöversikten var att belysa vuxna patienters upplevelser av att leva med avancerad hjärtsvikt. Metoden var en litteraturöversikt med systematisk sökstrategi. Inklusionskriterier var kvalitativa originalartiklar där deltagande personer hade diagnosen hjärtsvikt i avancerad fas och var över 18 år. Exklusionskriterium var artiklar som inte var godkända av en etisk kommitté alternativt etiknämnd. 15 kvalitativa originalartiklar inkluderades. En induktiv tematisk analys gjordes utifrån Braun och Clark (2006). Resultatet utmynnade i fyra teman och tio subteman. Det första temat “Symtomens inverkan på det dagliga livet” innefattade två subteman vilka var “Fysiska dimensioner” och “Psykiska dimensioner”. “Vårdrelaterade upplevelser” var det andra temat med “Uppfattningar om diagnos, prognos och behandling”, “Upplevelser av tillförlitlig och bristfällig vård” och “Ekonomisk börda” som subteman. Det tredje temat var “Copingstrategier” som inbegrep “Kognitiva copingstrategier” och “Religion och spiritualitet som copingstrategi”. Sista temat var “Emotionella och sociala aspekter av att leva och dö med avancerad hjärtsvikt”. Subteman var “Betydelsen av sociala relationer”, “Att förlora sin självständighet” och “Tankar och känslor inför framtiden och döden”. Slutsatsen var att patienters upplevelser av avancerad hjärtsvikt var mångfacetterade och hade inverkan på flera aspekter av deras liv. Överlag uttryckte patienterna ett behov av information och kunskap om sitt tillstånd. / Heart failure is a complex syndrome that has both high morbidity and mortality - and is becoming more and more common world-wide. Advanced heart failure can have significant consequences for the patient. It was from this standpoint we wanted to look into how patients with advanced heart failure experience their situation. The aim of the literature review was to elucidate adult patients’ experiences of living with advanced heart failure. The method used was a literature review with a systematic search strategy. The inclusion criteria were qualitative original articles in which participants were diagnosed with advanced heart failure and were adults (18 years old or older). The exclusion criterion were articles without approval from an ethics committee or a review board. In total 15 original articles were included in this paper. An inductive thematic analysis was made based on Braun and Clark (2006). The result led to four themes and ten subthemes. “The symptoms impact on daily life” included two subthemes which were “Physical dimensions” and “Psychological dimensions”. “Care-related experiences” were the second theme with “Perceptions of diagnosis, prognosis and treatment”, “Experiences of reliable and inadequate care” and “Financial burden” as subthemes. The third theme was “Coping strategies” that included “Cognitive coping strategies” and “Religion and spirituality as a coping strategy”. The last theme was “Emotional and social aspects of living with, and dying from, advanced heart failure”. Subthemes were “The importance of social relationships”, “To lose one's independence” and “Thoughts and feelings about the future and death”. The conclusion was that many patients’ experience of living with advanced heart failure were diverse and influenced several aspects of their lives. But in general, most patients expressed a need for information and knowledge about their condition.

Objective: Capacity building and training to improve contraceptive care is essential for patient-centered care and reproductive autonomy. This study assessed the feasibility of translating the knowledge and skills gained from contraception trainings into improvements in practice. Study Design: Participants completed surveys following contraceptive care trainings provided to family planning clinic and hospital obstetric providers and staff as a part of the Choose Well contraceptive access initiative in South Carolina. Surveys assessed participants’ intent to change their practice post-training and anticipated barriers to implementing change. A mixed-methods approach was utilized including descriptive analysis of Likert scale responses and thematic content analysis to synthesize open-ended, qualitative responses. Results: Data were collected from 160 contraceptive training sessions provided to 4814 clinical and administrative staff between 2017 and 2019. Post-training surveys were completed by 3464 participants (72%), and of these, 2978 answered questions related to the study outcomes. Most respondents (n = 2390; 80.7%) indicated intent to change their practice and 35.5% (n = 1044) anticipated barriers to implementing intended changes. Across all training categories, organizational factors (time constraints, policies and practices, infrastructure/resources) were the most frequently perceived barrier to improving contraceptive services. Structural factors related to cost for patients were also identified as barriers to IUD and implant provision. Conclusion: The trainings were successful in influencing family planning staff and providers’ intent to improve their contraceptive practices, yet some anticipated barriers in translating training into practice. Improvements in organizational and structural policies are critical to realizing the benefits of trainings in advancing quality contraceptive care. Implications: In addition to training, coordinated efforts to address organizational practices and resources, coupled with system-level policy changes are essential to facilitate the delivery and sustainability of patient-centered contraceptive care.

Bakgrunden beskriver hjärt-och lungräddning som en utmaning för ambulanssjuksköterskan.Utmaningen består i att göra det som upplevs vara rätt för patienten, anhöriga och vårdare.Trots begränsad tillgång på förhandsinformation och skiftande vårdmiljö, förväntasambulanssjuksköterskan ta snabba och livsavgörande beslut inom ett kort tidsfönster ochsamtidigt leda omvårdnadsarbetet för ambulansteamet och arbeta personcentrerat. Syftet var att beskriva etiska dilemman som uppstår hos ambulanspersonalen vid prehospitalahjärtstopp hos vuxna. Metoden var en litteraturstudie med systematisk ansats innehållande kvalitativa vetenskapligaartiklar från databaserna PubMed och Cinahl. Totalt har 15st vetenskapliga originalartiklarsom besvarade syftet inkluderats och efter kvalitetsgranskning gjordes en integrerad analys. Resultatet visar ett övergripande tema: Att göra det rätta. Temat delades in i trehuvudkategorier; Att bära ett stort ansvar i en allvarlig situation, När livet tar slut och Att orkaför allas skull. Etiska dilemman uttrycktes runt att göra rätt utifrån patienten perspektiv,reaktioner och interaktion med anhöriga, konflikter runt sina egna etiska värderingar ochrädslan för juridiska konsekvenser eller repressalier utifrån organisatoriska faktorer ochriktlinjer och då bli anklagad för att ha agerat fel vid hjärtstopp. Slutsatsen var att ambulanspersonal ibland upplever en svår etisk stress i situationer därförmågan att göra snabba och ofta livsavgörande beslut konkurrerar med denpersoncentrerade omvårdnaden och anhöriga i kris. Hantering av stressfyllda ochkänslomässiga situationer upplevdes som lättare i och med ökad erfarenhet och en stabilgrund bestående av personlig och professionell mognad och en bra relation med kollegor ocharbetsgivare. Vidare forskning på området skulle kunna förbättra personcentreradeomvårdnadsarbetet, förbättra arbetsmiljön och den psykiska hälsan hos ambulanspersonal. / Background describes cardio-pulmonary resuscitation as a major challenge to ambulance nurses. The challenge is to act upon the best interest for the patient, relatives and the caregiver. Despite limited initial information and great environmental diversities, the ambulance nurse is expected to make quick and life dependent decisions within a limited time frame and still lead the team through the intervention with a Patient-centered care focus. Aim was to describe ambulance personnel's experiences of ethical dilemmas in relation to out-of-hospital cardiac arrest in adults. Method used was a literature review with a systematic approach of 15 qualitative research articles from the databases PubMed and Cinahl. The articles were evaluated for quality and an integrated analysis was performed Results revealed an overall theme: To do the right thing. The theme consisted of three main categories; To have a great responsibility in a difficult situation, When life ends and To have the strength for everyone. Expressed ethical dilemmas concerned doing the right by the patient, reactions and interactions with relatives, conflicts between personal ethical values and the fear of legal consequences or being subject to reprisals and being accused for not adhering to organizational factors and policies in the event of a cardiac arrest. Conclusion made was that ambulance personnel are subject to severe ethical stress in situations where the ability to make quick and life dependent decisions compete with the patient centered care and relatives in crisis. Dealing with stressful and emotional situations became easier as experience was gained. Experience included a solid foundation of personal and professional maturity and a steady relationship with colleagues and employment organization. Further research is suggested to improve the person-centered care, improvement of working environment and psychological health for ambulance personnel.